SB 426 - This act provides uniform health insurance coverage for all Missourians.

GOVERNANCE - The program is administered by a 19 member Board: 10 members appointed by the Governor with the advice and consent of the Senate, 6 of whom are health providers and 4 of whom represent the elderly, employers, labor and the poor; six members are selected by and from the regional health planning and policy development districts created in the act; and the Directors of the Departments of Health, Social Services and Mental Health shall serve as ex officio members.

Members of the Board are not paid but are reimbursed for expenses.

The Board shall establish the budget, adopt fee schedules using 1996 as the base year, administer the program and the fund created to finance health care, establish standards for contracts with participating providers, and conduct utilization review. The Board shall develop a comprehensive state health care plan in cooperation with the advisory councils.

COVERAGE - Every Missouri resident, and any person for whom the Missouri health premium surcharge has been paid, is eligible for coverage. Certain services, including some cosmetic surgery, are not covered by the plan.

Services to inpatients provided by institutional providers shall be reimbursed on the basis of global budgets approved by the Board. Other providers shall be reimbursed on a fee-for- service basis. The fee schedule shall be applied throughout the state, based upon rates shall be negotiated with the professional association representing the providers.

FUNDING - Taxes received pursuant to this act, federal funds and state general revenue appropriations shall be placed in the Missouri Health Care Trust Fund which is created in this act.

Employers shall pay a health premium surcharge based upon the total amount paid to all employees. The rate is:

Five percent for four or fewer employees; Six percent for five to 49 employees; Eight percent for 50 to 99 employees; Nine percent for 100 to 249 employees; Ten percent for 250 to 499 employees; Twelve percent for more than 500 employees.

Employers who employ twenty-five or fewer employees are eligible for a tax credit for the first five years after the effective date of the tax in an amount of $25 per employee for the first year and diminishing by $5 per employee for each subsequent year.

All Missouri income taxpayers will also pay a surcharge:

If Adjusted Gross Income is: Tax rate is:

$5,000 to $25,OOO 1.2% of AGI

$25,000 to 50,000 $150 + 1.8% of AGI over $25,000

$50,000 to $75,000 $450 + 2.7% of AGI over $50,000

$75,000 to $100,000 $900 + 3.15% of AGI over $75,000

Over $100,000 $1,425 + 3.6% of AGI over $100,000

EFFECTIVE DATES: The act has a referendum clause which would submit the question to the voters in November, 1997. The Board of Governors will be appointed within thirty days of voter approval and the Department of Social Services shall apply to the federal government for the waivers necessary to fully implement this act. Provisions of the act pertaining to the powers and duties of the Board become effective on April 1 of the year following receipt of notice by the Revisor of Statutes that a waiver has been obtained. Provisions of the act imposing taxes are effective on January 1 of the year following the receipt of notice that the waivers have been obtained.
CHERYL GRAZIER